In mid-July, world leaders will gather in London to discuss a real and urgent need: increased funding for family planning. Over the past 15 years, the United States—one of the largest foreign aid donors in the world—has cut its funding level for family planning by at least 25 percent. Meanwhile, the demand for modern contraception and family planning information has only increased. By most accounts, an investment of approximately $6.7 billion is needed annually to meet current needs for family planning.
The summit documents, which is co-hosted by the Bill and Melinda Gates Foundation and the UK Department for International Development and supported by the US Agency for International Development and the UN Fund for Population Action, link the dearth of contraceptives and health services to poverty: women in “rich countries” have what they need, whereas women in “poor countries” don’t. This notion is supported by the fact that over 99 percent of maternal mortality happens in so-called developing countries.
This vision is not so much wrong as it is incomplete.
In early 2010, the medical journal The Lancet published new research on maternal mortality and morbidity. The research showed that improvements in maternal health — a good indicator for women’s access to health services overall — depend on 4 key factors, only one of which has to do with family planning: 1) lower fertility; 2) higher education levels for women and girls; 3) rising per capita income overall; and 4) access to skilled birth attendants.
Importantly, both the Global Family Planning Summit and research published in The Lancet potentially obscure the fact that adequate access to contraceptives and health services is a question of income rather than geography. To be blunt, a wealthy woman in a poor country is likely to have better access to care than a poor woman in a wealthy country.
Just as importantly, all four drivers of healthy motherhood depend on women’s ability to exercise their human rights, including the rights to quality health care, non-discrimination in education and health, and economic empowerment through job creation and protections for equality in the workplace.
But perhaps most to the point, the much-needed infusion of extra cash to development aid budgets for family planning is a means to an end. For the organizers of the London summit, that end is the provision of family planning services to poor women in the developing world. But even this very laudable objective is also a means to an end — or at least it should be.
Almost two decades ago the world’s governments for the first time promoted an understanding of individual empowerment as a vehicle for better policy outcomes on population growth, through the 1994 Cairo Declaration on Population and Development. The measures set out in this declaration supported the, at the time, radical notion that if individuals are empowered to make their own decisions about their family’s size and growth, these decisions, in the aggregate, will make for healthy and balanced societies. This notion departed from previous decades for population control through central planning and imposed government targets for fertility.
Of course a piece of paper is one thing. A real commitment to change is something else. In the 18 years that have passed since the adoption of the Cairo declaration, few governments have shown a sustained commitment to actually empower all individuals, equally, to make decisions about their families.
Some impose limits on family growth, punishing all women for wanting to have larger families than the government mandate. Others seek to limit the fertility of specific individuals within their population who for some reason or other are deemed unworthy parents, usually because of their color, class, family status, or gender identity. Still others force women to have larger families than that might have wanted through demonizing contraception, encouraging (or ignoring) early and forced marriage, and by perpetuating a culture where women without children are seen as somehow incomplete.
None of these situations promotes the kind of autonomy in family planning envisaged by the world community in 1994. And neither will merely stockpoling contraceptive methods.
The latter, however, will help. Here’s to hoping that the education, economic empowerment, and equality needed to ensure real family planning won’t be far behind.